affordable health care?






Reflex Hammer






Heart Doctor


Lung Doctor




Eye Doctor


Ear Doctor




Did the patient really need 5 referrals for a "complete" check-up? One Doctor, a trained Generalist could do the job--including the more intimate examinations.





So Why So Many Referrals?


The main reason is because the title Primary Care Physician (PCP) is all inclusive and misapplied. It has been defined by some as the “as the first medical contact with new patients, individuals first entering the Health Care (HC) System. As a result the category of PCPs includes:

            The Dermatologist (doesn’t check eyes )

            The Internist (refers intimate exams to gynecologists, proctologists)

            The Gynecologist (Refers skin conditions to dermatologists)


            The good Generalist (aka Primary Care) mange these problems—and then some!       

           An oft heard comment about Family Doctors and/or PCPs is “All s/he does is write prescriptions and refer me”.  When patient care is so fragmented who is in charge?   

Why did Primary Care Decline? 

The threat of mal-practice litigation! Actually the PCP should be an accomplished Generalist, a Doctor competent in the office practice and simple procedures of Specialty Care. But in the present environment that would be like driving with an insurance card but without a license. 

Is There a Remedy? 

Yes! To create uniform Primary Care Medicine through Primary Care Centers of America staffed by doctors trained in Primary Care Medicine and protected by the FTC (Federal Tort Claims Act 

 The doctors must be trained Generalists competent in many of the office procedures of the specialties as well as procedural medicine (minor surgery, remove ear wax, suture lacerations).  They will be responsible for the management of the care of their patients. 

Isn’t That Socialized Medicine?

What a question! You must be kidding!

Call it whatever you want! 

Most Americans receive medical Care through government auspices:


                        Medicaid (Federal and State for medically indigent)


                        Indian Health Services

                        Individually Covered Groups


                                 Addiction Services

                                 HIV sufferers        .

Benefits of Homogeneous General Medicine 

Summary in Brief 

A coordinated system of robust Primary (General Medicine) Care Centers will include these benefis: 

1.     Assure that General Medical Care will be practiced uniformly throughout the United States

2.     Quality of medical care will be improved

3.     General Medical Care will be available to everybody in the country at rates ranging from Zero to Affordable

4.     General Medical Care Centers will help coordinate National response to disasters plagues and terror.

5.     Decongest Emergency Rooms

6.     Save Money

7.     Lower Health Care Costs for:

a.     Individuals

b.     Families

c.     Enterprise

8.    Boost employment;








During the past 30 years Primary Care Medicine has become increasingly debilitated. Now it is only a shell game of its old self. How did this happen? How can it be fixed? 

If the  Supreme Court voids all or only portions of the Affordable Health Care Act some sort of substitute would probably be enacted.  That would give the Congress and Administration an opportunity to analyze the nature of Primary Care practice within the context of the delivery of Medical Care. 

Although High Tech Medical and Surgical specialties are practiced uniformly at the highest level throughout the country Primary Care doesn’t fare that well.  Too often people disparage their “Primary” as a doctor who “does nothing but write prescriptions and refer me.”  

Primary Care  has shriveled because too many of its practitioners have divested themselves of most of the office practices and responsibilities that were second nature to my generation of physician: namely the “ever available” Family Doctor, diagnostician and caretaker capable of performing many in-office procedures now referred out to the various Specialties. That Family Doctor assumed that those in his care were His (or Her) Patients, to be guarded and guided, not to be handed-off, needlessly referred   because a small laceration had to be sutured,  because ear-wax had to be removed  or a number of other minor problems could not be attended.   This retreat to safer harbors deprives patients of that parental assurance heretofore  associated with “The Family Doctor”, wastes their time in other waiting rooms and results in costly fee multipliers associated with unnecessary referrals. 

 A major reason for this more passive role assumed by the Primary Care Doctor is rooted in the threat of Medical Malpractice Litigation—because physicians crossing boundaries that define the specialties are unable (during interrogations or court appearances)  to answer the inevitable question “Doctor when did you pass the tests to get  credentialed in all [ent, gyn, surgery, dermatology] these specialties?  

Regardless  of outcome, the mere hint of legal attack initiates a chain reaction that may jeopardizes every aspect of a doctor’s professional life. The relations with HMOs and Hospitals become sensitized, insurance rates may rise, rumors are are floated. So why bother with these risks? Let’s play it safe. We will consult with families (no liability there), practice “Preventive Medicine (no liability there) and treat patients according to advice and prescriptions of their specialists (no jeopardy here). Our new credo:  Advise and Consent, that’s it.  Result: the patient loses a medical guardian and costs rise according to the number of referrals that might otherwise be avoided. ($50 billion? $100 billion? Who knows? 

 The remedy is seeded in the 8000 or more Primary Care Centers of America, not-for- profit corporate bodies funded in part by grants from the Department of Health via the Health Resources and Services Administration. Here Physician employees are protected from the eviscerating attacks of medical malpractice by the Federal Tort Claims Act. This Act gives citizens the right to sue the Government in Federal Court. Thus patients have recourse to litigation naming the physician as malefactor. Physicians on the other hand may be punished or fired but are relieved of blood curdling awards for “pain and suffering”, and unwelcome publicity these cases may attract.   

Were the number of these Primary  Care Centers increased to satisfy the needs of the nation, properly trained  Physician employees would be free  to cross Specialty boundaries and enjoy a robust and fulfilling office practice in General Medicine.  

The other substantial benefits of robust and Affordable Primary Care are addressed

 more completely at and its links